Kristina Löwing

Activity focused and goal directed therapy for children with cerebral palsy – Do goals make a difference?

Objective. To compare the effects of goal directed functional therapy (GDT) to activity focused therapy (AT) for preschool children with cerebral palsy (CP) on everyday activities and gross motor function. Another aim was to evaluate goal attainment in the GDT group. Methods. A prospective intervention study comparing two types of intervention carried out in ecological settings. Forty-four children with CP, (25 boys, 19 girls; mean age 4 year 1 month [SD 1 year 5 month]), Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels I–IV participated. Twenty-two children were recruited to the GDT group and 22 to the AT group. Outcome measures were the Pediatric Evaluation of Disability Inventory (PEDI), and the Gross Motor Function Measure-66. Furthermore, goal attainment scaling (GAS) was used in the GDT group. The assessments were performed before and after an intervention period of 12 weeks. Results. The children in the GDT group improved more in most aspects of everyday activities measured by the PEDI than the children in the AT group (p < 0.001). Only functional skills in social function did not differ between the groups. Furthermore, gross motor function improved more in the GDT group than in the AT group (p < 0.001). Goal attainment to the expected level or higher was achieved in 93/110 goals in the GDT group. The variance of improvements in the different PEDI scales in the GDT group could not be explained by either age, sex, distribution of CP, GMFCS or MACS levels. Conclusion. GDT demonstrated clear gains for children with cerebral palsy in everyday activities and gross motor function in comparison to AT.

Self-care and mobility skills in children with cerebral palsy, related to their manual ability and gross motor function classifications

Aim  The aim of this study was to investigate the acquisition of self‐care and mobility skills in children with cerebral palsy (CP) in relation to their manual ability and gross motor function.

Does loss of spasticity matter? A 10-year follow-up after selective dorsal rhizotomy in cerebral palsy.

Aim  The aim of this study was to evaluate the long‐term effects of selective dorsal rhizotomy (SDR) in children with cerebral palsy (CP).

Developmental profiles and auditory perception in 25 children attending special preschools for language‐impaired children

Aim: To study different developmental profiles and auditory perception in a representative group of children with language impairment (LI). Methods: A multidisciplinary investigation was carried out in a group of 25 children attending units specifically for language‐impaired children. An assessment of the cognitive level, motor performance, behaviour and auditory perception was performed and the results were compared with those for age‐matched groups of children. Results: Among those with moderate or severe language impairment (LI), around 90% had additional developmental disorders. In three tests of auditory perception, children with LI had problems with working memory and speech discrimination. No problems were found with the childrens temporal resolution in auditory perception. Another conclusion from the auditory perceptual tests was that the childrens cognitive abilities were important for their success in these tests.

Goal-directed functional therapy: a longitudinal study on gross motor function in children with cerebral palsy.

Purpose. To investigate gross motor function and goal attainment in children with cerebral palsy before, during and after goal-directed functional therapy (GDT), to evaluate body functions, and explore relationships. Method. Prospective longitudinal intervention study. Twenty-two children, uni- or bilateral CP, 1–6 years (mean: 46 months SD: 16 months), classified in GMFCS and MACS level I–IV participated. Outcome measures were Gross Motor Function Measure (GMFM-66), performed at seven occasions, Goal Attainment Scale, assessments of passive range of motion, spasticity and selective motor control (SMC). Baseline, the GDT-intervention and the follow-up period were 12 weeks each. Results. Improvements were demonstrated in GMFM-66 during the intervention (mean difference: 5.07, CI: 3.8–6.4, p < 0.001). The baseline and follow-up assessments were stable. Evaluations of ankle dorsiflexion displayed small improvement (mean difference: 9°, CI: 5–13, p < 0.001). Estimations of spasticity and SMC did not demonstrate significant changes. Goal attainment to the expected level or higher was achieved in 93/110 goals and further improved at the long-term follow-up (103/110). Conclusion. Gross motor function improved during GDT, and was maintained 12 weeks later. The goals were reached to a high extent, and the children gradually progressed towards their goals after the end of the intervention. The therapy did not induce any deterioration of body functions.

Effect of intravenous pamidronate therapy on everyday activities in children with osteogenesis imperfecta

Aim: To evaluate the effect of intravenous pamidronate therapy on everyday activities, well‐being, skeletal pain and bone density in children with osteogenesis imperfecta (OI).

Botulinumtoxin A treatment in toddlers with cerebral palsy

Aims:  In this study the aim was to evaluate the effect of botulinum toxin A (BoNT‐A) treatment on muscle tone, contracture development and gait pattern in young children with cerebral palsy (CP).

Does goal setting in activity‐focused interventions for children with cerebral palsy influence treatment outcome?

Today, treatment for children with cerebral palsy predominantly aims at improving the childrens possibilities to perform everyday activities in their natural environment. The activities in focus for intervention are often expressed as specific goals, frequently defined in a collaborative goal‐setting process between professionals and parents. The role of goal setting to improve the outcome of the intervention has not been shown in the literature so far. Thus, the aim of this systematic review was to explore if goal setting has an impact on treatment outcome assessed by standardized measures. CINAHL and MEDLINE were searched from January 2000 to October 2012, resulting in a final selection of 13 articles, six of which were randomized controlled trials. Methodological quality was assessed and study characteristics were analysed descriptively. Subject characteristics, type of intervention/s, frequency, and intensity of therapy varied largely. Outcome was assessed by standardized outcome measures as well as evaluated through aspects of goal attainment. Most studies showed robust within‐group changes according to study‐appropriate standardized measures, whereas the between‐group comparisons exhibited less consistent differences in outcome. The review does not provide support for a positive effect of goal setting per se on treatment outcome. Studies that specifically measure the effect of goal setting on treatment outcome are needed.

Reliability of the selective motor control scale in children with cerebral palsy

The aim of this study was to determine inter-rater and test–retest reliability of a scale for assessing selective motor control (SMC) in the dorsiflexors of the ankle. A consecutive sample of 40 children with cerebral palsy (CP), aged 3–16 years (median age 7 years) participated in the study. Thirty children had a bilateral form of CP and 10 a unilateral form, and they were classified into Gross Motor Function Classification System levels I–V. The SMC scale ranges from 0 (indicating no ankle movement) to 4 (indicating isolated SMC through available range of motion with balanced activity in m. tibialis anterior). The inter-rater reliability was assessed simultaneously by three assessors. The test–retest reliability was achieved through a second assessment of 29 of the children, at a different occasion. The statistical analysis included a weighted kappa coefficient of agreement (Kw). The inter-rater reliability showed fair/good to strong agreement between pairs of raters (Kw=0.58–0.77). The test–retest reliability was strong (Kw=0.88–1). Since the inter-rater reliability varied between fair/good to strong and the test–retest reliability was strong, we conclude that repeated evaluations should preferably be performed by the same rater.

Exploring the relationship of family goals and scores on standardized measures in children with cerebral palsy, using the ICF-CY.

Aim: To explore the relationships of family selected goals and scores on standardized measures using the ICF-CY as a classification system. Methods: Goal attainment scaling (GAS)-goals (n = 110) of 22 children, 11 girls, 1–6 years, bilateral or unilateral cerebral palsy, GMFCS I-IV and MACS I–IV were linked to the ICF-CY. The children had participated in goal-directed therapy during 12 weeks. GAS-goals, baseline assessments and change scores from PEDI and GMFM-66 were used to explore the relationships. Results: All GAS-goals were classified in the Activity and Participation domain within ICF-CY. The number of GAS-goals correlated to baseline scores in PEDI and GMFM-66. The change scores in PEDI and GMFM-66 correlated to goal attainment in the Mobility and the Self-Care chapter. Conclusions: The family goals were reflected in standardized measures. The combined use of standardized and individual measures offers a possibility to explore the focus in therapy and the impact in children with cerebral palsy.